A 5-year-old boy with multiple scalp nodules following a holiday in South America--'shocking live surprise'.

In April 2009, a 5-year-old boy went on a holiday to Costa Rica. They visited the west coast (Guanacaste) and central highlands region (Arenal Volcano). A week after their return to the UK, the parents noticed multiple lumps on the boy’s scalp. Three nodules, about 1 cm in diameter each, spread over both sides of the scalp were noted. The nodules were fi rm and mildly tender with central scabs. A few days later, central pores were noted on the top of these nodules (fi gure 1A). Inspection of the lesions revealed the protrusion of breathing tubes of larvae through the pores (fi gure 1B). Human botfl y (Dermatobia hominis) myiasis was diagnosed. Two days later, the boy underwent surgical removal of fi ve botfl y larvae from three scalp lesions under general anaesthesia (fi gure 1C, D). A small incision was made on the side of the nodule and larvae were squeezed out. Four weeks after the procedure, he was very well with complete resolution of scalp lesions.